Healthcare Provider Details

I. General information

NPI: 1316944572
Provider Name (Legal Business Name): ANTHONY CHARLIES DE MORY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2005
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date: 03/20/2006
Reactivation Date: 05/25/2006

III. Provider practice location address

2900 12TH AVE N STE 400E
BILLINGS MT
59101-7514
US

IV. Provider business mailing address

2900 12TH AVE N STE 400E
BILLINGS MT
59101-7514
US

V. Phone/Fax

Practice location:
  • Phone: 406-237-5770
  • Fax: 406-237-5768
Mailing address:
  • Phone: 406-237-5770
  • Fax: 406-237-5768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberM4027
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD161523
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: